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Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry

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Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry Downloaded from www.waitangitribunal.govt.nz HAUORA Downloaded from www.waitangitribunal.govt.nz Downloaded from www.waitangitribunal.govt.nz Downloaded from www.waitangitribunal.govt.nz Downloaded from www.waitangitribunal.govt.nz HAUORA Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry W A I 2 5 7 5 W A I T A N G I T R I B U N A L R E P O R T 2 0 1 9 Downloaded from www.waitangitribunal.govt.nz Downloaded from www.waitangitribunal.govt.nz The cover design by Cliff Whiting invokes the signing of the Treaty of Waitangi and the consequent interwoven development of Māori and Pākehā history in New Zealand as it continuously unfolds in a pattern not yet completely known The karakia on pages xviii and xix is from H Wahanui, whakapapa manuscript (unpublished, 1894), and from page 56 of Pei Te Hurinui Jones, He Mahi Mārei-kura : A Treasury of Sacred Writings (Hamilton : Aka and Associates, 2013) National Library of New Zealand Cataloguing-in-Publication Data A catalogue record for this book is available from the National Library of New Zealand ISBN 978-1-86956-331-8 (pbk) ISBN 978-1-86956-332-5 (PDF) www.waitangitribunal.govt.nz Typeset by the Waitangi Tribunal This report was previously released online in pre-publication format in 2019 as Hauora : Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry – Pre-publication Version This edition published 2019 by Legislation Direct, Lower Hutt, New Zealand Printed by Printlink, Lower Hutt, New Zealand 23 22 21 20 19 5 4 3 2 1 Set in Adobe Minion Pro and Cronos Pro Opticals Downloaded from www.waitangitribunal.govt.nz Downloaded from www.waitangitribunal.govt.nz CONTENTS Letter of transmittal xxxi Glossary xxi Abbreviations xxiii Chapter 1 : Introduction Pūnganangana ki tawhito-o-te-rangi e tū nei 1 1 1 The Health Services and Outcomes Kaupapa Inquiry – stage one 1 1 1 1 Introduction 1 1 1 2 The inquiry process to date 2 1 1 2 1 The initial claim for urgency 2 1 1 2 2 The kaupapa inquiry programme 3 1 1 2 3 A staged approach to hearing health-related claims 4 1 1 2 4 The stage one hearings 6 1 2 The stage one participants 6 1 2 1 The claimants 7 1 2 1 1 Māori Primary Health Organisations and Providers claim (Wai 1315) 7 1 2 1 2 The National Hauora Coalition claim (Wai 2687) 9 1 2 2 The Crown 10 1 2 3 The interested parties 11 1 2 3 1 The Ngā Ariki Kaipūtahi claim (Wai 507) 12 1 2 3 2 Wai 762, Wai 1196, Wai 1531, Wai 1957, Wai 2064, Wai 2165, and Wai 2382 12 1 2 3 3 The Ngāti Kiore and Te Kohatutaka hapū of Mangataipa claim (Wai 1732) 12 1 2 3 4 The Māori Health Disparities (Te ORA) claim (Wai 2499) 12 1 2 3 5 The District Māori Council claim (Wai 2623) 13 1 2 3 6 Wai 2634, Wai 2643, Wai 2647, Wai 2650, and Wai 2688 13 1 2 3 7 The New Zealand Māori Council Health claim (Wai 2644) 13 1 2 3 8 The Counties Manukau Health claim (Wai 2702) 14 1 2 3 9 The Māori Nurses claim (Wai 2713) 14 1 2 3 10 The Health Services (Tamihere) claim (Wai 2720) 14 1 2 3 11 The Natural and Indigenous Health Care Treatments claim (Wai 2727) 14 v Downloaded from www.waitangitribunal.govt.nz Downloaded from www.waitangitribunal.govt.nz Contents Chapter 1—continued 1 2 The stage one participants—continued 1 2 3 The interested parties—continued 1 2 3 12 The Mental Health and Addiction (Fergusson-Tibble) claim (Wai 2738) 15 1 2 3 13 Additional claims represented by Te Mata Law Limited 15 1 3 The scope of this report 15 1 4 The structure of this report 16 Chapter 2 : Why is this Inquiry Needed ? He ngana riri ; he ngana tauā 17 2 1 Introduction 17 2 2 Māori health outcomes at the turn of the twenty-first century 18 2 3 Why are Māori health outcomes so bad compared with those of Non-Māori ? 20 2 4 The reset of the primary health system, 2000–02 : a sense of hope 22 2 5 Māori health inequities persist 23 Chapter 3 : Treaty Principles Ue-ue ’Nuku ; Ue-ue Rangi 27 3 1 Introduction 27 3 2 Partnership 27 3 3 Active protection 30 3 4 Equity 33 3 5 Options 35 3 6 Conclusion 37 3 6 1 Is the New Zealand Public Health and Disability Act Treaty-compliant ? 37 3 6 2 Are the funding arrangements for the primary health care system Treaty-compliant ? 37 3 6 3 Is the way health entities are held to account Treaty-compliant ? 37 3 6 4 Is partnership for Māori in the primary health care framework Treaty-compliant ? 38 Chapter 4 : The Primary Health Care Legislative and Policy Framework Tē tūngia te kawaru rā 39 4 1 Introduction 39 4 2 The structure of the primary health care system 40 4 2 1 The New Zealand Public Health and Disability Act 40 4 2 2 The role of the Minister of Health 40 4 2 3 The role of the Ministry of Health 42 4 2 4 The roles of district health boards 44 vi Downloaded from www.waitangitribunal.govt.nz Downloaded from www.waitangitribunal.govt.nz Contents 4 2 5 The role of primary health organisations and providers 45 4 2 6 Relevance to this stage one inquiry 47 4 3 Setting the framework for primary health care 48 4 3 1 The New Zealand Health Strategy 48 4 3 2 The Primary Health Care Strategy 48 4 3 3 He Korowai Oranga 50 4 3 4 Relevance to this stage one inquiry 51 4 4 Funding arrangements for primary health care 51 4 4 1 Vote Health funding 51 4 4 2 Capitation funding for primary health care 52 4 4 3 Other capitated funding streams 55 4 4 4 Other funding to primary health organisations 57 4 4 5 Relevance to this stage one inquiry 58 4 5 Holding entities to account for performance 58 4 5 1 Government expectations and directions 58 4 5 2 Planning documents 59 4 5 2 1 Annual plans 59 4 5 2 2 Regional service plans 60 4 5 3 Relevance to this stage one inquiry 60 4 5 4 Accountability documents 60 4 5 4 1 Statement of intent 61 4 5 4 2 Statement of performance expectations 61 4 5 4 3 Crown Funding Agreement 61 4 5 4 4 Annual report 62 4 5 5 Financial and non-financial performance measures 62 4 5 6 Managing arrangements between district health boards and primary health organisations 63 4 5 7 Relevance to this stage one inquiry 64 Chapter 5 : Is the New Zealand Public Health and Disability Act 2000 Treaty-compliant ? Ko te hau tonga ka maranga mai rā 65 5 1 Introduction 65 5 2 Equity and the New Zealand Public Health and Disability Act 66 5 3 Equity and the policy framework 69 5 4 Health discourse 73 5 5 The Treaty clause in the New Zealand Public Health and Disability Act 75 5 6 Treaty principles in the primary health care framework – the ‘three Ps’ 79 5 7 The Act’s provisions for district health boards 83 5 7 1 Māori representatives on the boards of district health boards 83 5 7 2 Partnership arrangements with district health boards 86 5 8 Treaty obligations in lower-level accountability documents 93 5 9 Tribunal findings 96 vii Downloaded from www.waitangitribunal.govt.nz Downloaded from www.waitangitribunal.govt.nz Contents Chapter 6 : Are the Funding Arrangements for the Primary Health Care System Treaty-compliant ? Toki tā wahie te toki nui 99 6 1 Introduction 99 6 2 The funding for primary health care 99 6 3 Were Māori primary health organisations adequately funded at the point of establishment ? 101 6 4 Are the funding arrangements for the primary health care system adequate to pursue equity of health outcomes for Māori meaningfully ? 103 6 4 1 Funding for district health boards 103 6 4 2 Capitation and other funding 104 6 4 3 The impact on Māori primary health organisations and health providers 107 6 5 Tribunal findings 115 Chapter 7 : Is the Way Health Entities are Held to Account Treaty-compliant ? Toki tā wahie te toki roa 119 7 1 Introduction 119 7 2 Accountability mechanisms for primary health care 119 7 3 Holding district health boards to account 120 7 4 The importance of effective measures and reporting 122 7 5 Holding primary health organisations and providers to account 127 7 6 The detail of data and information collected from primary health organisations and providers 129 7 7 External monitoring of the Ministry of Health 134 7 8 Accountability in a permissive system 136 7 9 Tribunal findings 138 Chapter 8 : Is Partnership for Māori in the Primary Health Care Framework Treaty-compliant ? Toki tā wahie te toki matarau ; Ka whanatu au ka hahau i te takapū o Rangi e tū nei 139 8 1 Introduction 139 8 2 Designing the primary health care framework 140 8 3 Māori experiences of working in the primary health care sector 142 8 3 1 Te Kete Hauora 143 8 3 2 District health boards 145 8 3 3 Māori primary health organisations and providers 149 8 4 Inaction in the face of need 151 8 5 Providing culturally appropriate services 155 8 6 Tribunal findings 159 viii Downloaded from www.waitangitribunal.govt.nz Downloaded from www.waitangitribunal.govt.nz Contents Chapter 9 : Prejudice and Recommendations Whakataka te hau ki te muri ; Whakataka te hau ki te tonga kia mākinakina ki uta ; Kia mātaratara ki tai kia hiia ake te ātākura, he tio, he huka, he hau-hūnga 161 9 1 Prejudice 161 9 2 Recommendations 162 9 3 Overarching recommendations 162 9 3 1 The Treaty of Waitangi and its principles 162 9 3 2 Equity 164 9 4 Structural reform – an Independent Māori Health Authority 164 9 5 Specific recommendations 166 9 5 1 Funding 166 9 5 2 Accountability 167 9 5 3 A Treaty-compliant primary health care framework 169 9 5 4 Acknowledgement 170 Appendix i : Statement of Issues 173 1 0 Introduction 173 2 0 Equity 174 3 0 The primary healthcare framework 174 4 0 Māori solutions 174 5 0 Funding 175 6 0 Policy and strategy 175 7 0 Accountability 175 8 0 Social policy 175 9 0 Treaty principles 176 10 0 Prejudice 176 11 0 Recommendations 176 Appendix ii : Interested Parties Granted Leave to Participate in
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